Provider Demographics
NPI:1619224862
Name:SAIIA, MIKE (PTA)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:SAIIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6505
Mailing Address - Country:US
Mailing Address - Phone:614-470-6240
Mailing Address - Fax:614-470-6244
Practice Address - Street 1:156 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6505
Practice Address - Country:US
Practice Address - Phone:614-470-6240
Practice Address - Fax:614-470-6244
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant